Hot Coding Topics / Provider News

Check CCI Edits For New Vaccine Administration Codes

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.

For instance, you’ll find vaccine administration codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid])and 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) bundled into new vaccine administration code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component), and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

In addition, CCI bundles the new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

CCI Has Good News on the Modifier Front

Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you’ll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly-revised debridement codes 11042-11044. In the past, if your pediatrician performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services and you append the appropriate modifier.

Swapped pairs: In addition, CCI did an about-face on several edits this round. In the past, if you reported 94660 (Continuous positive airway pressure ventilation) or 94662 (Continuous negative pressure ventilation) with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny

...

Comments Off on Check CCI Edits For New Vaccine Administration Codes
February 3, 2011
CPT 2011 / Hot Coding Topics

CPT 2011: Vaccine Product to 90460, 90461 Crosswalk

How to count components for Boostrix, Pediarix – and other immunizations.

Excited by the new vaccine administration codes’ payment per component but not sure how many components specific vaccines have? This chart does the work for you.

Find the product name for a quick cross reference to how many components the vaccine includes and the administration with counseling code combination to report using the new pediatric/adolescent codes.

Note: The ICD-9 vaccine product code listed in the chart uses the generalized vaccine product code (V06.8, Need for prophylactic vaccination and inoculation against other combinations of diseases). For vaccine administration provided outside of a preventive medicine service, the American Academy of Pediatrics recommends using V06.8 for combination vaccines that do not have their own individual single ICD-9 code.

Vaccine Product Manufacturer Components CPT Product Code Number  of Components CPT 2011 Administration with Counseling Code ICD-9-CM 2011 Code
ActHIB Sanofi Pasteur Hib 90648 1 90460 V03.81
Adacel Sanofi Pasteur Tdap (tetanus- diphtheria-acellular pertussis) 90715 3 90460, +90461 x 2 V06.1
Boostrix GlaxoSmithKline Tdap 90715 3 90460, +90461 x 2 V06.1
Cervarix GlaxoSmithKline HPV 90650 1 90460 V04.89
Comvax Merck HepB-Hib 90748 2 90460, +90461 V06.8
Daptacel

...

Comments Off on CPT 2011: Vaccine Product to 90460, 90461 Crosswalk
January 7, 2011
2011 Medicare Physician Fee Schedule / CPT 2011 / CPT and RBRVS Annual Symposium / Hot Coding Topics

Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs

Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.

The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.

The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.

CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.

The work and total RVUs for the codes include:

<td width="203"
Code PE  RVU  RUC Proposed PE  RVU MPFS Accepted Total RVUs
90460 0.20 0.17 0.59
90461 0.16 0.15 0.3
90465

...

Comments Off on Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs
November 29, 2010
CPT 2011 / Hot Coding Topics / Multiple component vaccines

CPT 2011: Goodbye 90465-90474, Hello Vaccine Administration Component Coding

You’ll soon capture counseling per disease.

For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.

Although multiple component vaccines require counseling on each disease, physicians have only been able to capture counseling for vaccine administration once per administration. CPT 2011 solves the problem with new immunization administration with counseling codes that you’ll code per vaccine component. 

CPT 2011 deletes 90465-90468 (Immunization administration younger than 8 years of age … when the physician counsels the patient/family … per day). Codes 90471-90474 (Immunization administration …) remain.

Use 90460 as Vaccine Administration With Counseling Base Code

No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration, you’ll assign one code for each vaccine’s initial component:

  • 90460 — Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

 Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.

CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes “any route of administration.” You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.

 Step 2:  Report Second Vaccine Component With +90461

Coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:

  • +90461 — Immunization administration through 18 years of age via any route

...

Comments Off on CPT 2011: Goodbye 90465-90474, Hello Vaccine Administration Component Coding
November 9, 2010
Provider News

HCPCS 2010: CMS Debuts New J Codes

Synvisc, penicillin get new codes — along with injectibles for neurology, bleeding. Hot on the heels of the new CPT codes, CMS follows suit by publishing the 2010 HCPCS code set, posted on the CMS Web site on Nov. 3. You’ll find scores of changes. What follows is a small sampling of what you’ll face in 2010: Synvisc: HCPCS will [...] Related articles:

  1. Which HCPCS Code Should I Use for Eovist MRI contrast? Question: Which HCPCS code should I use to report...
  2. 2 New HCPCS Codes for H1N1 Vaccine AdministrationPlus: New Bevacizumab code is effective Oct. 1. If you’re...
  3. 2010 CPT Category II & III Codes You Might Miss Yes, our CPT books are fountains of knowledge, but...

Comments Off on HCPCS 2010: CMS Debuts New J Codes
November 10, 2009
Hot Coding Topics

Track Payer’s Preferred H1N1 Admin Code — or Risk Rejections

Code 488.1 does not = confirmed lab. Swine flu has made an early arrival in several states and in your 2009 preventive and sick coding. To avoid denials for H1N1 vaccination administration, you’re going to have to check which of three administration code options your major payers want. “Some payers want you to use the new [...] Related articles:

  1. 2 New HCPCS Codes for H1N1 Vaccine AdministrationPlus: New Bevacizumab code is effective Oct. 1. If you’re...
  2. Correct ICD-9 Coding for H1N1 (Swine Flu) Before you carry your swine flu diagnosis over to...
  3. Capture Vaccine Admin Without Charging Products These VFC FAQs help you report the seemingly impossible....

Comments Off on Track Payer’s Preferred H1N1 Admin Code — or Risk Rejections
November 3, 2009
Audit / Hot Coding Topics / Oig

Service Doesn’t Meet Incident-To Rules? Report Under NPP’s NPI

Heads up: These vaccine admin codes are excluded from incident-to requirements. Incident-to rules don’t always apply to diagnostic services, but many medical practices aren’t aware of that. And based on a new wave of scrutiny directed toward incident-to claims, you should know physician supervision rules inside and out. A recent audit from the HHS Office of the Inspector [...] Related articles:

  1. Nonphysician Providers and Incident-To: Your Coding Questions AnsweredHere’s why you should keep your physicians’ work schedules on...
  2. Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill...
  3. 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t...

Comments Off on Service Doesn’t Meet Incident-To Rules? Report Under NPP’s NPI
October 20, 2009